Lumbar Decompression

Lumbar decompression is indicated for patients that have narrowing of the spinal canal which often causes individuals to have
difficulty standing or walking.

Lumbar decompression involves a small incision approximately 1-1.5 inches in the low back for one level and a bit more for each additional level. An operating microscope is used to visualize the surgical area allowing the use of such a small incision. Bone and ligament are removed over the spinal canal thereby opening up the area over and around the nerves. Finally, the incision is closed with layers of buried sutures. A skin sealant is applied lastly making bandages unnecessary.

The procedure takes about 60-90 minutes for one level, and most individuals are allowed to go home the same day of the procedure.

Recovery

The postoperative course is as follows:

Risks of Surgery

No surgery is without risk, but fortunately the risks associated with lumbar decompression are rare. The most common risks are:

  • Infection – Sometimes requires antibiotics alone. Other times may need repeat surgery to wash out the infection.
  • Back pain – the surgical pain will generally subside in a few weeks, but there is often a sore area where the scar remains.
  • Continued leg and/or buttock pain – Sometimes the surgery does not relieve the pain. This can be a sign of nerve damage.
  • Spinal fluid leak – Occasionally the sheath around the nerve gets a leak while moving the nerve out of the way. This is usually found at the time of surgery and repaired. Sometimes it requires another surgery to close the leak.
  • Scarring – With any surgery, scar tissue can be problematic. With laminectomy, the scarring that is most problematic is that around the nerve root. This improves with exercise.
  • Recurrent stenosis – Most patients will slowly develop more narrowing in the spine over time after the procedure. For some, it may never be tight enough to need another surgery, but others may require re-opening of the spine and sometimes even larger procedures such as fusion. 

Other risks which are more serious but very rare can include:

  • Nerve injury – Great care is taken to protect the nerve while doing a microdiscectomy, but on occasion the nerve is so traumatized by the herniation that even slight movement can cause further injury.
  • Spinal instability – In some, the removal of the ligament and bone required to access the disc fragment can lead to an increase of abnormal motion in the spine. Occasionally this can require further surgery.
  • Great vessel and/or bowel injury – This is extremely rare, but can occur if the anterior ring of the disc is very weak and is breached during the procedure. This can be a life threatening complication and is carefully avoided.
  • Paralysis – As the lumbar spine is well below the spinal cord, this would be extremely rare, but must always be included as a risk in any spinal procedure.

Typical recovery is as follows. One’s back is quite sore for the first few days and weeks due to the surgery. Sometimes there can be quite a bit of bruising. The buttock, thigh and leg pain is generally much improved. Numbness and/or weakness takes much longer to start improving.

Over the next 6-10 weeks, scar tissue forms where the surgery was done, causing slight recurrence of symptoms as before the surgery but not as severe. This usually peaks at about 2 months after the surgery.

Over the next year, the scar tissue breaks down slowly as one exercises and stretches regularly. It never goes away completely, but generally gets to an acceptable level.

The success rate of treating lumbar stenosis surgically is very high, and most have great satisfaction with the surgery. However, the surgery does not “fix” one’s back in the sense that the degenerative process is still going on. Therefore it is important to continue to care for your back for the rest of your life. This includes regular cardiovascular exercises like biking, swimming and/or walking 3-5 days per week for at least 30 minutes each time as well as daily stretching exercise.

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